If you’re 65 or older, be sure to mark Medicare open enrollment on your calendar: October 15 through December 7, 2025. It is an important time of year to review your current medical coverage and healthcare needs and select the most suitable Medicare plan for the new year.
Even if you’re already enrolled in Medicare, it’s still a good idea to review your plan, considering that coverage and your health needs may change from year to year. If you will become eligible for Medicare coverage for the first time in 2026, now is a good time to start learning about the different types of Medicare (e.g., Medicare Parts A, B, C, and D) and what they mean for you.
The open enrollment period for Medicare 2026 begins October 15, 2025, and ends on December 7, 2025. Here’s what you need to know about Medicare to ensure you’re prepared, especially for Medicare Part D open enrollment.
Back to topWhat are the different types of Medicare?
Medicare is an insurance plan provided by the federal government and overseen by the Centers for Medicare and Medicaid Services (CMS). Medicare coverage is divided into four general sections, each of which covers different services. You must be enrolled in Parts A and B to be eligible for Part D.
Medicare Part A covers hospital expenses (e.g., it pays for costs if you are hospitalized or placed in a nursing home). Medicare Part B covers outpatient services, such as doctor’s visits, labs, immunizations, Xrays, and surgeries that don’t require you to stay overnight in a hospital.
Medicare Part C, also known as Medicare Advantage, is a type of Medicare coverage offered by private insurance companies that contract with CMS. It is available to anyone enrolled in Medicare Parts A and B. Medicare Advantage plans cover not only the services provided by Parts A and B but may also offer dental, vision, and/or prescription-drug coverage.
Medicare Part D is a supplemental form of Medicare that specifically covers prescription drug services. If you are enrolled in Parts A and B, you can enroll in a Part D plan for prescription coverage.
Back to topWhy would you want to get Medicare Part D?
Medicare Part A covers only medications that you receive while you are in a hospital or a skilled nursing facility. Medicare Part B covers only a limited number of medications and typically only if they are administered in an outpatient setting (such as a doctor’s office or clinic). Examples include vaccines, injectable medications, and medications administered via IV.
This lack of regular prescription coverage can be a significant problem for older adults. According to the 2021–2022 National Health Interview Survey, more than 88% of adults aged 65+ take at least one prescription drug per month. If you’re 65 or older, it’s worth looking into how signing up for Medicare Part D coverage may save you money, especially if you are already taking multiple prescriptions.
Back to topWho qualifies for Medicare Part D?
Anyone eligible for Medicare coverage is also eligible for Medicare Part D. Generally, you will qualify for Medicare if you are 65 or older. People who are about to turn 65 can apply for Medicare outside of the regular open enrollment period during their 65th birthday month as well as the three months before or after (although coverage does not start until you turn 65).
If you are under 65, you may also qualify under special circumstances, such as if you’re disabled (and have been receiving Social Security Disability Insurance checks for at least 24 months), have end-stage renal disease, or have ALS (e.g., Lou Gehrig’s disease).
Back to topHow can you sign up for Medicare Part D?
Once you are enrolled in Medicare Parts A and B, you can sign up for Medicare Part D coverage on the Medicare Plan Finder page. You can review and select health plans after entering your ZIP code and answering a series of questions. If you are already enrolled in a Medicare Part D plan, your plan will automatically renew. So, technically, you’ll only need to visit the website if you want to change plans.
However, it’s still a good idea to review your plan annually in case your current plan has changed or to determine whether a different plan would better meet your current needs.
Back to topHow much does it cost?
The Medicare Plan Finder page provides pricing information. You will be prompted to type in your list of medications and select your preferred pharmacy. The website will then display a list of plans from which you can choose. The cost of your Medicare Part D plan may vary based on the plan you select and where you live. You’ll want to compare plan costs and copays to determine which plan will work best for you.
Back to top2026 Medicare Part D Highlights
Here is some important information about Medicare Part D for 2026.
Cost Improvements Due to the Inflation Reduction Act
The 2022 Inflation Reduction Act included several updates to Medicare Part D. Improvements began in 2023 and will continue to be implemented until 2029. Here are some key highlights for 2026 that may help reduce your prescription drug costs.
Discounts on common medications
Medicare is now able to negotiate discounts with drug manufacturers. For 2026, they negotiated discounts on 10 prescription drugs that are among the costliest and most used by people on Medicare Part D. In fact, the American Association of Retired Persons (AARP) reports that roughly nine million people who were enrolled in Medicare Part D in 2023 used one or more of these 10 drugs. AARP reports that Medicare Part D enrollees who take one or more of these drugs are expected to save a combined $1.5 billion in out-of-pocket expenses due to savings on copays.
The drugs on the list are all medications for which no generic exists. The drugs include those that treat diabetes, heart failure, blood clots, arthritis, cancer, and other illnesses. AARP has published a list of drugs that will be discounted in 2026, along with the price discounts patients can expect.
Insulin may cost less than $35
Previous changes to Medicare Part D meant that you could get insulin for a copay of $35, regardless of whether you’d met your deductible or your total out-of-pocket maximum. Starting in 2026, your insulin copay (before you reach your total out-of-pocket max) may be less than $35. That’s because the fee is now $35 or 25% of the negotiated price for your prescription, whichever is less.
Pricing changes for 2026
Here are the price updates for various elements of Medicare Part D for 2026.
- The initial deductible will increase by $25 to $615. This means you’ll pay slightly more before Medicare Part D begins paying its share if you have a plan with the highest possible deductible.
After your deductible is met, you’ll pay a copay that varies based on the type of drug and your income level. You’ll be responsible for those copays until you meet your RxMOOP (maximum out-ofpocket limit for formulary prescriptions). Note: You no longer need to worry about the coverage gap (aka the “donut hole”) because that was eliminated in 2025.
Some plans may offer a $0 deductible for lower-cost (Tier 1 and Tier 2) drugs. In this case, you may pay a small copay for these drugs, even if you have not met your deductible. All CDCrecommended adult vaccines are typically free of charge even if your deductible hasn’t been met, and you’ll never pay more than $35 for insulin.
- RxMOOP (maximum out-of-pocket limit for formulary prescriptions) is now $2,100 per year, an increase of $100 from last year. This means that after you incur $2,100 in out-ofpocket costs for prescriptions included in your Medicare formulary, you will not pay anything extra for formulary drugs through the end of the year.
To understand more about the Medicare Part D changes for 2026 and what they mean for you, talk to your pharmacist at your local Good Neighbor Pharmacy.